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Rising Interest In Diabetes Remission

In the past few years, scientific journals have seen an explosion of interest in diabetes remission.It is well established that gastric sleeve surgery can put diabetes into remission.

However, many of the recent publications describe education, diet, and exercise  interventions. These interventions are causing people with type 2, adult-onset diabetes to  go months and even years with normal HbA1C values, without needing glucose-lowering  medication.  

The exercise and diet plans are what doctors might  expect and probably even what they have been  teaching for years. Intensity and support stand out as  the new features making old advice more effective.  Exercise and diet interventions with high success  rates involve multiple visits spread over weeks or  months for education, guided exercise, and  support. Studies are measuring remission and  partial remission rates at 50% to 79% of  participants.1,2 After the education programs  end, remission rates drop to 25% to 30%.  

However, this is still triple the usual long-term  remission rates.  Patients most likely to achieve remission have  recent, adult-onset, type 2 diabetes. The longer  diabetics go without major changes in diet or  exercise, the lower the odds of remission.2 Nevertheless, programs that even approach remission are likely to improve various health out comes for patients.  

General Practitioners can provide their patients access to intensive type 2 diabetes rehab  through CDMP and T2D referrals to exercise physiology at Advanced Physiotherapy.  With state-of-the-art facilities and special interest in treating metabolic conditions, exer cise physiologists at Advanced Physiotherapy can implement an effective physical activity  routine that is realistic and client centred, working towards long-term habit forming.  

Our approach includes:  

• Identifying and addressing emotional distress about diagnoses or other life events  that may impact treatment goals 

• Defining self-care behaviours that can be confidently achieved 

• Collaborative goal setting 

• Goals and milestones to be achieved 

• Weight, body composition, daily activity levels, etc. 

• Timeframes 

• Barriers 

• Continued support 


1. Umphonsathien M, Prutanopajai P, AiamORan J, Thararoop T, Karin A, Kanjanapha C, Jiamjarasrangsi  W, Khovidhunkit W. Immediate and longterm effects of a verylowcalorie diet on diabetes remission  and glycemic control in obese Thai patients with type 2 diabetes mellitus. Food Science & Nutrition. 2019  Mar;7(3):1113-22. 

2. RiedLarsen M, Johansen MY, MacDonald CS, Hansen KB, Christensen R, WedellNeergaard AS, Pilmark  NS, Langberg H, Vaag AA, Pedersen BK, Karstoft K. Type 2 diabetes remission one year after an inten sive lifestyle intervention: A secondary analysis of a randomized clinical trial. Diabetes, Obesity and Me tabolism. 2019 Jun 5. 

3. Zhyzneuskaya SV, Al-Mrabeh AH, Barnes AC, et al. 66-OR: Remission of Type 2 Diabetes for Two Years  Is Associated with Full Recovery of Beta-Cell Functional Mass in the Diabetes Remission Clinical Trial  (DiRECT). Diabetes. 2019; 68 (Supplement 1): DOI: 10.2337/db19-66-OR. 

4. Hopkins MD, Taylor R, Lean ME. The DiRECT principles: giving Type 2 diabetes remission programmes the  best chance of success. Diabetic Medicine. 2019;36(12):1703-4.  

5. Qumby K, George C, Hambleton I, Olivier P, Unwin N. 3461 A community-based, low calorie dietary  intervention for the prevention and remission of type 2 diabetes mellitus. Journal of Clinical and Transla tional Science. 2019 Mar;3(s1):137. 

6. Lean ME, Brosnahan N, Kean S. Two-year results of the randomised Diabetes Remission Clinical Trial  (DiRECT). Lancet Diabetes and Endocrinology. 2019 Feb 13. 

7. Peterli R, Wölnerhanssen BK, Peters T, Vetter D, Kröll D, Borbély Y, Schultes B, Beglinger C, Drewe J,  Schiesser M, Nett P. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass  on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. JAMA. 2018 Jan  16;319(3):255-65. 

8. MarkleReid M, Ploeg J, Fraser KD, Fisher KA, Bartholomew A, Griffith LE, Miklavcic J, Gafni A, Thabane  L, Upshur R. Community Program Improves Quality of Life and SelfManagement in Older Adults with  Diabetes Mellitus and Comorbidity. Journal of the American Geriatrics Society. 2018 Feb;66(2):263-73.


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